|关键词||Vaspin 血液透析 胰岛素抵抗 外周血管疾病|
|其他题名||The Relationship Between Vaspin And Insulin Resistance And Peripheral Artery Disease In Maintenance Hemodialysis Patients|
[目的 ] 血浆Vaspin与糖尿病患者的胰岛素抵抗相关。胰岛素抵抗普遍存在于维持性血液透析患者中，且与心管并发症相关。本研究旨在探讨浆Vaspin与维持性血液透析患者的胰岛素抵抗及外周管疾病关系。
[Objective] Vaspin was correlated to insulin resistance in diabetes. Insulin resistance existed in MHD patients and had a relationship with cardiovascular complications of MHD patients. The purpose of our study was to explore the relationship between vaspin and insulin resistance and peripheral artery disease(PAD) in MHD patients .
[Methods] We randomly included 72 cases of MHD patients who took regular hemodialysis therapy in Peking University Third Hospital from 12,2015 to 3,2016 and divided them into non-diabetic subgroup and diabetic subgroup, with 46 cases in non-diabetic subgroup and 26 cases in diabetic subgroup. 20 cases of healthy person who took physical examination in Peking University Third Hospital were recruited as health control. Height, weight and the blood pressure were measured in all objects. Hemoglobin （HGB）, plasma creatine （Cr）, fasting blood glucose （FBG）, fasting insulin （FINS）, total cholesterol （TC）, triglyceride（TG）, High-density-lipoprotein cholesterol（HDL-C）, low-density-lipoprotein cholesterol（LDL-C）and plasma vaspin were examined in all objects. In addition to these, parathyroid hormone （PTH）and high sensitive c-reative protein （hsCRP）were examined in MHD patients. At the same time, we measured the blood pressure of upper and lower limbs on the side without vessel fistula in MHD patients and calculated ABI with the formula ABI=lower limbs pressure/upper limbs pressure, we defined ABI＜0.9 as PAD.Homeostasis model assessment of insulin resistance （HOMA-IR）were calculated in all objects. We used software SPSS 22.0 to analyze all data.
1.General information comparison: There was no difference in sex ratio，systolic blood pressure，BMI，FBG，TC，TG，LDL-C between MHD patients and health control（P＞0.05）. MHD patients were older in age , higher in insulin level and lower in diastolic blood pressure，HGB，eGFR and HDL-C level compared with health control（P＜0.05）.
2.MHD group had a higher HOMA-IR than health control [2.44（1.38，4.28）vs 1.49（1.00，1.89）]（P＜0.05），diabetic subgroup had a higher HOMA-IR than non-diabetic subgroup[3.31（2.35，5.18）vs 2.01（1.10，3.72）]（P＜0.05）.
3.MHD group had a higher vaspin level than health control [0.28（0.15，0.65） vs 0.07（0.05，0.08）]（P＜0.05）and no significant difference was observed between diabetic subgroup and diabetic subgroup in vaspin level（P＞0.05）.
4.In MHD patients，vaspin was positively correlated with TC，HDL-C，LDL-C（r=0.244、0.292、0.277 P=0.041、0.014、0.020）and negatively correlated with FINS，HOMA-IR （r=-0.273、-0.313 P=0.022、0.008）.
5.In non-diabetic subgroup，vaspin was positively correlated with HDL-C，LDL-C（r=0.425、0.313 P=0.004、0.036）and negatively correlated with FINS，HOMA-IR （r=-0.392、-0.411 P=0.008、0.005）. In diabetic subgroup，vaspin was positively correlated with HGB（r=0.673，P＜0.001）and negatively correlated with ALB（r=-0.427 P=0.033）.
6.PAD group had a lower vaspin level [0.16（0.06，0.27）vs 0.33（0.18，0.73）] and a higher HOMA-IR when compared with non-PAD group[5.57（3.14，22.41）vs 2.20（1.37，3.99）]（P＜0.05）.FINS and HOMA-IR may be factors for PAD.
1.No matter with diabetes or not, MHD patients exist insulin resistance.
2.Vaspin level is elevated in MHD patients and it negatively correlates with HOMA-IR.
3.The vaspin level had no difference between diabetic and non-diabetic patients. In non-diabetic patients vaspin is still negatively correlates with HOMA-IR, however the correlation disappeared in non-diabetic patients.
4.PAD patients have a lower vaspin level and a higher insulin resistance level when compared with non-PAD patients.Elevated vaspin may be a protective factor for PAD.
|苏凯杰. 脂肪因子Vaspin与血液透析患者的胰岛素抵抗及外周血管疾病的相关性研究[D]. 北京大学第三临床医学院. 北京大学,2016.|